Amplitude-Integrated EEG and Cerebral Near-Infrared Spectroscopy in Cooled, Asphyxiated Infants.

OBJECTIVE: To assess the predictive value of amplitude-integrated electroencephalography EEG (aEEG) and near-infrared spectroscopy (NIRS) during therapeutic hypothermia. PATIENTS AND METHODS: We studied 39 cooled, asphyxiated infants. We assessed aEEG and calculated mean regional cerebral oxygen saturation (rcSO2) during and after treatment. At 30 months, we performed a neurological examination and administered the Bayley Scales of Infant and Toddler Development, 3rd edition. We calculated the odds ratios (ORs) of abnormal aEEG and rcSO2 for severely abnormal outcome. RESULTS: At 6 and 12 hours, severely abnormal aEEGs predicted severely abnormal outcomes (OR, 7.7 [95% confidence interval, CI, 1.39-42.6] and 24.4 [95% CI 4.2-143] respectively), as did epileptic activity (OR 28.9, 4.6-183). During the first 48 hours, rcSO2 was not associated with outcome, but at 72 hours after birth and after rewarming it was, with ORs for severely abnormal outcomes of 12.8 (1.31-124) and 21.6 (1.05-189), respectively. In multivariate analyses, aEEG and rcSO2 remained independently predictive in the model at 48 hours and significantly from 72 hours after birth onward. CONCLUSION: aEEG was a strong predictor of adverse outcome. After 48 hours of cooling, a higher rcSO2 was associated with a severely abnormal outcome, adding to the predictive value of aEEG in cooled, asphyxiated infants.

[Two-year follow-up of infants born at 24 weeks gestation; first outcomes following implementation of the new 'Guideline for perinatal policy in cases of extreme prematurity']. / Follow-up na 2 jaar van kinderen geboren bij 24 weken.

OBJECTIVE: Since 2010 the guideline 'Guideline for perinatal policy in cases of extreme prematurity' has advised an active policy in infants born at 24 weeks gestation. We investigated how infants born at 24 and 25 weeks gestation in the first year following the implementation of the guideline had developed by the age of 2 years. DESIGN: Retrospective national cohort study. METHOD: The study population consisted of all surviving infants born in the Netherlands at 24 or 25 weeks gestation in the period from 1 October 2010 to 1 October 2011. At a corrected age of 2 years the children underwent a general physical and neurological examination, and their cognitive scores were determined on the 'Bayley scales of infant and toddler development' (Bayley III). Examinations took place in the 10 neonatal intensive care units (NICU's) in the Netherlands. RESULTS: Of 185 extremely premature infants, 166 were admitted to a NICU. A total of 95 survived to a corrected age of 2 years; 78 (82%) children were examined. Their average cognitive score on the Bayley III scale was 88 (SD: 16). Among the children born at 24 weeks gestation, 20% had mild disabilities and 20% had moderate to severe disabilities. Among the children born at 25 weeks gestation, 17% had mild disabilities and 12% had moderate to severe disabilities. CONCLUSION: Of the children born at 24 weeks gestation in the first year after the introduction of active policy in the Netherlands and surviving to 2 years of age (46%), more than half had developed without disabilities. This was comparable to children born at 25 weeks gestation. Of all children born at 24 weeks gestation, 25% survived to 2 years of age without disabilities.

The prevalence of feeding problems in children formerly treated in a neonatal intensive care unit.

OBJECTIVE: To determine the prevalence of oral feeding problems in neonatal intensive care unit (NICU) graduates at 1 to 2 years, and to identify clinical risk factors during NICU admission. STUDY DESIGN: Observational cohort study of 378 children, who received level III/IV NICU care for 4 days or more in 2011 to 2012, chromosomal abnormalities excluded. We detected feeding problems in four gestational age (GA) groups (<28, 28 to 31, 32 to 36 weeks, and term-borns) using the Dutch standardized Screeningslijst Eetgedrag Peuters, and collected clinical factors for logistic regression analyses. RESULTS: The prevalence of feeding problems was higher in NICU (20.4%) than in reference (15.0%) population (P=0.024), but similar for all GA groups (P=0.468). Prolonged tube feeding, that is, >30 days (odds ratio (OR) 2.50, confidence interval (CI) 1.13 to 5.56) and being born small for GA (OR 4.79, CI 1.64 to 14.03) were the most prevalent risk factors in children with GA ⩾32 and GA <32 weeks, respectively. CONCLUSION: Feeding problems are more prevalent in NICU graduates, with prolonged tube feeding as most important risk factor.

Amplitude integrated electroencephalographic activity in infants with congenital heart disease before surgery.

BACKGROUND: Infants with congenital heart disease (CHD) are at risk for brain injury. An accurate tool to monitor brain function is amplitude integrated EEG (aEEG). It records both background patterns and electrographic seizure activity (EA). AIMS: Our aim was to determine aEEG patterns in infants with CHD and to determine the differences between infants with a cyanotic or an acyanotic CHD. STUDY DESIGN AND SUBJECTS: Sixty-two full term newborns had either a cyanotic CHD (transposition of the great arteries (n=24)) or an acyanotic CHD (hypoplastic left heart syndrome (n=26), critical aortic valve stenosis (n=1) or aortic coarctation (n=11)). The background patterns, sleep-wake cycling (SWC), and EA were assessed. The first 72h after starting prostaglandin E(1)-therapy were used for analysis. RESULTS: The background patterns were mildly abnormal in 45% of the infants and severely abnormal at some point during the recording in 14% of the infants. We found no differences in background patterns between the two groups. EA was present in 12 (19%) infants. EA was more frequent in infants with acyanotic CHD (OR 9.4, 95% CI 1.1-78, p=0.039). SWC was equally frequent in infants with cyanotic and infants with acyanotic CHD. A severely abnormal aEEG and EA were associated with more profound acidosis. CONCLUSIONS: Before surgery the majority of infants with a CHD had an abnormal aEEG. aEEG helped to identify EA and it was a useful tool to evaluate brain function prior to surgery in CHD.

The prognostic value of amplitude integrated EEG in neonatal sepsis and/or meningitis.

AIM: To investigate the longitudinal course and prognostic value of amplitude integrated EEG (aEEG) in infants with neonatal sepsis or meningitis. METHODS: Amplitude integrated EEG recordings of 22 infants with sepsis/meningitis were retrospectively evaluated. Mean gestational age was 38 weeks (range: 34-42 weeks). Thirteen infants had meningitis. Survivors were seen for neurological follow-up. Four infants died, two were severely abnormal at 24 months. Amplitude integrated EEG background pattern, sleep wake cycling (SWC) and electrographic seizure activity (EA) were appraised. RESULTS: All infants with continuous low voltage or flat trace on aEEG (n = 4) had an adverse outcome. Low voltage aEEGs (n = 9) had a positive LR (LR+) for an adverse outcome of 5.3 (95% CI: 1.9-14.8) at 6 h and 8.3 (95% CI: 1.3-55) at 24 h after admission. EA was more frequent in infants with adverse outcome (p < 0.01) and had a LR+ for adverse outcome of 10.6 (95% CI: 1.5-76). SWC appeared more frequent in infants with good outcome (p < 0.05). CONCLUSION: Low voltage background pattern, SWC and EA on aEEG are helpful to predict neurological outcome in infants with neonatal sepsis or meningitis.

Burst suppression on amplitude-integrated electroencephalogram may be induced by midazolam: a report on three cases.

UNLABELLED: Continuous amplitude-integrated electroencephalogram (aEEG) recording with a cerebral function monitor is a useful tool to evaluate prognoses following perinatal asphyxia in term infants. Drugs may change the pattern of the conventional EEG. This report presents three infants treated with midazolam for status epilepticus and repetitive seizures who proved resistant to other anticonvulsants (phenobarbitone, lidocaine). The infants developed burst suppression patterns on aEEG concurrent with high serum levels of midazolam (900-7093 microg l(-1)). Following discontinuation of midazolam treatment, serum levels normalized and background patterns returned to normal voltage traces. CONCLUSION: These findings indicated that midazolam can cause burst suppression on aEEG. Therefore, the prognostic value of aEEG is limited in case of high serum levels of midazolam. Serum levels of midazolam should be measured in infants who have burst suppression patterns on aEEG during midazolam treatment.